An Overview of Iliopsoas Syndrome

Iliopsoas syndrome is an umbrella term that encompasses several conditions that affect the inner hip muscle that bends the leg toward the body. Generally caused by an overuse injury, iliopsoas pain commonly affects those who perform repeated hip flexion movements, such as gymnasts, dancers, runners, and soccer players.

The term iliopsoas syndrome is often used interchangeably with psoas syndrome, iliopsoas tendonitis, snapping hip syndrome, and iliopsoas bursitis, though there are some clinical differences between some of these.

This article explains the symptoms and causes of iliopsoas syndrome, as well as how it is diagnosed and treated.

Illiopsoas Syndrome Symptoms

Symptoms of iliopsoas syndrome include:

• Pain and/or stiffness in the hip and thigh area
  
• Pain that worsens when doing anything that bends the hip (e.g., walking, climbing stairs, squatting, sitting)
• Hip or groin clicking or snapping that you can hear or feel while performing these actions
• Tenderness in the hip and groin area

Typically, movements that involve bringing your knee toward your chest can worsen the pain.

What Causes Iliopsoas Pain?

The iliopsoas muscles are the anterior hip muscles (muscles on the front of the hip. They are complex muscles made up of the psoas major, the psoas minor, and the iliacus.

Within the hip joint are several bursae, small, fluid-filled sacs that lie between bones and soft tissues. Bursae reduce friction and provide cushioning to allow tendons, muscles, and other structures to glide over bony prominences effortlessly.

Two of these bursae—the greater trochanteric bursa and the iliopsoas bursa—can become inflamed, setting the stage for iliopsoas syndrome.

• Iliopsoas bursitis occurs when the iliopsoas bursa (located between the iliopsoas tendon and the inside of the hip joint) becomes inflamed and irritated.
• Iliopsoas tendonitis, or hip tendonitis, occurs when the iliopsoas tendon (the tendon that attaches the thigh bone to the iliopsoas muscle) becomes inflamed and irritated.

Iliopsoas bursitis and tendonitis are most commonly caused by an overuse injury during intense activities, such as running, rowing, cycling, or strength training.

Diagnosis

A healthcare provider is typically able to diagnose iliopsoas syndrome based on symptom history and a hip examination.

Imaging tests, such as magnetic resonance imaging (MRI) and X-ray, may be used to rule out other injuries or conditions, such as muscle tears.

Iliopsoas Syndrome Treatment

Most mild cases of hip bursitis and hip tendonitis can be managed using the RICE method. RICE stands for:

• Rest: Avoid bearing weight on the hip for the first few days after an injury.
• Ice: Apply ice immediately after the injury to keep the swelling down. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly on the skin.
• Compression: To prevent additional swelling, lightly wrap the area in a soft bandage or wear compression shorts.
• Elevation: As often as possible, rest with your leg raised up higher than your heart.

Medical Treatment

Non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) and Aleve (naproxen sodium) can also alleviate pain and reduce inflammation.

Sometimes, steroid injections are used to relieve symptoms. If symptoms persist or return, additional steroid injections can be administered as necessary.

After pain and swelling subside, you may need to see a physical therapist, or your healthcare provider may start you on a mild exercise program to gradually improve hip strength and flexibility.

In severe cases where pain persists despite taking these measures, your healthcare provider may recommend surgical interventions. However, these instances are rare due to the risks of muscle weakness and nerve damage.

Summary

Iliopsoas syndrome is a broad term that encompasses a variety of possible injuries to the iliopsoas muscle.

Injuries to this area of the hip are caused by overuse and often affect athletes and dancers.

Mild cases of iliopsoas pain can usually be treated at home with conservative measures. In other cases, steroid injections and physical therapy may be needed.